Medical examinations before
surgical abortion
Moscow Regional Research Institute of
Obstetrics & Gynecology
Olga Serova, MD, professor
Abortions and deliveries in Moscow Region
Girls up to 14 years
2002г. – 0,11%;
2003г. – 0,08%.
100,8
92,8
93,4
91,1
93,8
79,4
52,3
46,2
47,3
44,6
46,3
44,4
75,6
45,9
71,5
44,1
69,3
47,2
63,5
50,9
62,8 61,5
61,4
59,5
54,3
58
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
abortions
delivery
Modern Technologies of
Induced Abortion
• Surgical abortion
• Vacuum aspiration (mini-abortion)
• Medical methods (mifepristone)
Early abortion complication
•
•
•
•
Cervical trauma
Incomplete abortion / Failed abortion
Haemorrhage
Uterine perforation
Maternal mortality in Moscow Region
69,2
70
60
52,5
50
40
24,2
30
20
10
20,8
15,1
8,7
2,6
6,8
0
1981-1992
1993-2004
ectopic pregnancy
induced abortion
criminal abortion
others
Abortion Complication
medical abortion
vacuum aspiration
surgical abortion
14%
12%
10%
8%
6%
4%
0%
Haemorrhage
Endometritis
2% 2%
Incomplete abortion
Risk Factors in developing of abortion
complications






Chronical inflammatory diseases
STI
Scar utery
Leomyoma uterus
Frequent changes sex partners
Operations in women’ hystory
Rehabilitation after abortion
Before abortion
 During abortion
 In early post-abortion period
 Long-term period
Pre-abortion care
• Confirming the pregnancy
• Physical examination and pre-existing
conditions
• Information and counseling
Physical examination before
abortion
• Ultrasound scanning
• Measuring haemoglobin and haematocrit (Нв, Ht)
• Tests for ABO and Rhesus (Rh) blood group typing
• Tests for RW, HIV, HbsAg, HCV
• Laboratory testing for RTIs
• Cervix Cytology
• Others – in special indications
Ultrasound scanning
• Confirm pregnancy and estimate its duration
• Detection of ectopic pregnancy
• Pre-existing conditions (leiomyoma uterus,
abnormalities etc)
• Intrauterine device
Blood Laboratory Testing
• Measuring hemoglobin and haematocrit – to detect
anemia and blood diseases
• Tests for ABO and Rhesus (Rh) blood group typing –
for anti-D immunoglobulin injection
• Tests for RW, HIV, HBsAg, HCV – for prevention
abortion complication
For excluding RTI
• Bacterioscopy is not enough information
• RTI – for inflammatory diseases
diagnostic’s
Rehabilitation during abortion




Methods of abortion
Abortion clinics or facilities
Pain management
Emergency treatment
Rehabilitation in post-abortion
period
 After medical abortion – 2 hours observation,
ultrasound – in 7-10 days
 After surgical abortion - observation in a hospital,
physical examination and ultrasound before
discharge
Inflammatory Diseases Prevention
Medical abortion
•
Pre-existing STI
•
Colpitis
•
Bacterial vaginosis
Vacuum
aspiration
• Chomical inflammatory
diseases
• Uterus’ scar
• Repeated operative
treatment in women’s life
Surgical abortion
• In any cases
Inflammatory Diseases Prevention
 After medical abortion – Cefuroxim 150 mg (one dose)
 During vacuum aspiration - Cefuroxim 150 mg (one dose)
 After surgical abortion – antibiotics prevention courses
during 5-10 days
Effectiveness prevention' programs after
abortion (1 year follow-up)
4,0%
3,5%
3,0%
2,5%
2,0%
1,5%
1,0%
0,5%
0,0%
4,0%
2,0%
0,0%
surgical abortion
vacuum
aspiration
medical abortion
inflammatory diseases